Malignant mesothelioma is difficult to treat for several reasons. Like all cancers, it becomes more difficult to treat after the disease progresses. And because mesothelioma doesn't show its symptoms until decades after the patient is exposed, it is often not found until it has reached advanced stages. Unfortunately, mesothelioma is also easily misdiagnosed, further delaying treatment. When the disease is found, it frequently doesn't respond well to conventional cancer treatments. The nature of mesothelioma -- which affects tissues that line some of the major organs of the body -- means that it cannot easily be removed with surgery. And treatment can also be complicated by the demographics of its victims -- generally, men over the age of 50 -- whose health may not allow very radical treatments.

All of this means that even newly diagnosed mesothelioma patients sometimes are given a very bad chance of recovery (prognosis) by their doctors. Statistics are hard to come by, but British scientists suggest that 10% of newly diagnosed mesothelioma patients will live for at least three more years; 5% will live five years or more. For patients in the first stage, 50% live for at least two more years. But doctors can be wrong, and a mesothelioma diagnosis is not necessarily a death sentence. Famed scientist Stephen Jay Gould lived with peritoneal mesothelioma for nearly 20 years. He eventually died from a different type of cancer.

There are four stages of malignant mesothelioma, which measure how far the disease has progressed. How a patient's mesothelioma is treated depends largely on which stage he or she is in when the disease is found.

• Stage I: Localized mesothelioma that exists only in the lungs, the diaphragm or the pericardial lining.
• Stage II: Advanced mesothelioma that has spread into the lymph nodes of the chest.
• Stage III: Advanced mesotheioma that has spread into the wall of the chest, the center of the chest, the lining of the heart and the diaphragm. Stage III malignant mesothelioma may or may not have spread to the lymph nodes.
• Stage IV: Advanced mesothelioma that has spread far from the chest and abdomen into other organs.

Surgery

Patients with Stage I or milder Stage II mesothelioma are generally offered one or more of the conventional cancer treatments: surgery, radiation and chemotherapy. For early-stage patients, surgery for mesothelioma aims to cure the disease by literally cutting the cancer out of the patient's body. The most common type of surgery for pleural mesothelioma is a pleurectomy/decortication, which is where doctors remove all or part of the tissues lining the lungs and chest cavity. If doctors find that they can't remove the cancer without removing the lung underneath those tissues, they may remove one lung as well; this is called a pneumonectomy. A more radical type of surgery for pleural mesothelioma is called an extrapleural pneunonectomy (EPP). In an EPP, doctors remove parts of the pleura, one lung, the lining of the heart and the diaphragm. These are difficult and dangerous surgeries that doctors won't recommend lightly.

Patients with peritoneal mesothelioma -- the kind that affects the abdomen -- may be offered cytoredutive surgery. In this surgery, doctors are trying to remove all of the cancerous tissue they can find in the abdomen and gut. They may also choose to do a peritonectomy -- removal of the entire lining of the abdomen. Again, this is not an easy surgery and may not be possible for everyone, but it has been successful in some patients. Patients with pericardial mesothelioma are not generally offered surgery.

Radiation and Chemotherapy

In addition to or instead of surgery, doctors may offer an early-stage mesothelioma patient chemotherapy, radiation or both. Radiation and chemotherapy are designed to kill the cancer cells without killing the patient. Unfortuantely, in order to kill the cancerous cells, these treatments often kill healthy cells as well. This is why cancer patients often lose their hair, have trouble eating and feel generally weak and sick during treatment. Doctors who prescribe chemotherapy or radiation may also suggest dietary supplements or other measures to control these symptoms.

Chemotherapy gives patients a drug designed to attack the cancer cells as they divide. The drug is swallowed or injected into the bloodstream regularly over a period of weeks or months, in cycles that give a patient some recovery time in between treatments. Patients can live at home and just go into a doctor's office for the treatment; sometimes, they can even have the treatments at home. In some cases, doctors may choose to apply chemotherapy drugs directly to the cancerous tissue; this requires surgery, so patients must check into a hospital. There are many different kinds of chemotherapy drugs, and scientists are trying to develop better ones every day.

Radiation therapy seeks to kill the cancer cells with high-energy rays of radiation, such as x-rays, that stop them from growing. In external-beam radiation, patients endure directed beams of radiation aimed at the parts of their bodies where the cancer lies. This treatment lasts about 30 minutes a day and is given in the exact same way each day over a period of weeks. In internal radiation therapy (brachytherapy), doctors put a container of radioactive material next to the cancerous tissue, using surgery or an existing body cavity. Some will be left in the body; others will be removed and replaced. Finally, radiation is sometimes administered through radioactive drugs (radiopharmaceuticals), which are injected, swallowed or placed directly into a body cavity.

Advanced Stages

A patient with a pessimistic prognosis may still be offered surgery, radiation or chemotherapy. In this case, the treatment is palliative -- designed to help the patient feel better and slow the cancer, not to cure the disease. The most common pallative surgery for mesothelioma is surgery to drain the chest of the fluid buildup that mesothelioma causes. A patient may undergo this therapy several times, as the fluid tends to come back. Under limited circumstances, doctors may also choose to surgically remove cancerous parts of the pleura, to allow the patient to breathe more easily. Similarly, palliative radiation and chemotherapy for mesothelioma patients is designed to shrink tumors that are interfering with the patient's breathing and other functions. These will only be offered if doctors believe the side effects will be less painful than the disease itself. Other types of pallative care include strong pain medication and full-time hospice care.

Experimental Hope

Under certain conditions, mesothelioma patients may be offered a chance to participate in clinical trials of new drugs, gene therapy, immunotherapy or other experimental treatments. These clinical trials use methods that have not yet been approved by the U.S. Food and Drug Administration. For that reason, they carry an increased risk -- but they can also offer great hope to patients for whom conventional treatments have failed. Some of these treatments have shown promise for mesothelioma patients, but must be more thoroughly tested to ensure that they're safe for patients. Patients who are interested in experiemental care should discuss it at length with their loved ones and their doctors.